ter should fit snugly.
Hold the ENBREL® vial upright on your flat work surface and push the plunger down until all the liquid from the syringe is in the ENBREL® vial. You may see foaming (bubbles) in the vial. This is normal.
Gently swirl the ENBREL® vial in a circular motion to dissolve the powder. If you used the dose tray to hold your ENBREL® vial, take the vial (with the vial adapter and syringe still attached) out of the dose tray, and gently swirl the vial in a circular motion to dissolve the powder.
DO NOT SHAKE. Wait until all the powder dissolves (usually less than 10 minutes). The solution should be clear and colorless. After the powder has completely dissolved, foam (bubbles) may still be present. This is normal. Do not inject the solution if it is discolored, contains lumps, flakes, or particles. If all the powder in the ENBREL® vial is not dissolved or there are particles present after 10 minutes, call 1-888-4ENBREL (1-888-436-2735) for assistance.
Turn the ENBREL® vial upside down. Hold the syringe at eye level and slowly pull the plunger down to the unit markings on the side of the syringe that correspond with your/your child’s dose. For adult patients, remove the entire volume (1 mL), unless otherwise instructed by your doctor. Be careful not to pull the plunger completely out of the syringe. Some white foam may remain in the ENBREL® vial. This is normal.
Check for air bubbles in the syringe. Gently tap the syringe to make any air bubbles rise to the top of the syringe. Slowly push the plunger up to remove the air bubbles. If you push solution back into the vial, slowly pull back on the plunger to again draw the correct amount of solution back into the syringe.
Remove the syringe from the vial adapter, by holding the vial adapter with one hand and turning the syringe counterclockwise with your other hand. Do not touch or bump the plunger. Place the ENBREL® vial with the vial adapter on your flat work surface.
Continue to hold the barrel of the syringe. With your free hand, twist the 27-gauge needle onto the tip of the syringe until it fits snugly. Do not remove the needle cover from the syringe. Place the syringe on your flat work surface until you are ready to inject ENBREL®.
GO TO STEP 4: CHOOSING AND PREPARING AN INJECTION SITE.
STEP 2B: Free-Hand Method
If you are preparing a dose from an ENBREL® vial that was previously used, go to STEP 3: Preparing Additional Doses from a Single ENBREL® Vial.
Remove the pink plastic cap from the ENBREL® vial. Do not remove the gray stopper or silver metal ring around the top of the ENBREL® vial. Write the date you mix the powder and solution on the supplied “Mixing Date:” sticker and attach it to the ENBREL® vial.
Place the ENBREL® vial on your flat work surface. Use one alcohol swab to clean the gray stopper on the ENBREL® vial. Do not touch the gray stopper with your hands.
Open the wrapper that contains the 25-gauge needle by peeling apart the tabs and set the needle aside for later use. The 25-gauge needle will be used to mix the liquid with the powder and for withdrawing ENBREL® from the vial.
Slide the plunger into the flange end of the syringe.
Attach the plunger to the gray rubber stopper in the syringe by turning the plunger clockwise until a slight resistance is felt.
Remove the twist-off cap from the prefilled diluent syringe by turning counter-clockwise. Do not touch or bump the plunger. Doing so could cause the liquid to leak out. You may see a drop of liquid when removing t |
